Post-adjusting means for wire and nail directing apparatus



M. F. STEPHENS POST-ADJUSTING MEANS FOR WIRE AND Nov. 23, 1948.

NAIL DIREGTING APPARATUS Filed Jan. 22, 1945 2 Sheets-Sheet-l I IIW H HI ,1 INVENTOR- j affxsic phens. 2.25.1 BY

W A TTORNEYS- Patented Nov. 23. 1 948 UNITED STATES 2,454,680POST-ADJUSTING MEANSFORWIRE A NI) "NAIL DmEc'rINGnPPARA'r-Us MarionFdStephens, ;S.u1liyal Ap l c tionJanuan j 45 .Se ia N -*5 3.954

.4 Claims. My invention I relates to post-adjusting -means designedprimarily for directing apparatus particularly adapted for precisiontechnique *for intracapsula'r fracture of the hip but is not limited tosuch use.

In the extensive practice of hip-nailing, --there has been developedwhatis called the Smith- -Peterson technique. It comprises the insertion ofaguiding pin or wire in the shaft of the femur, .the wire serving toguide a cannulatedvitallium Smith-Peterson nail inserted in such amanner -:thatit parallels'and is in contact with the-medial and anteriorcortex of the neck of the femur. The guide, commonly called a Steinmannpin,is

usually about three-thirty-seconds of an inch -=:by ten inches and isremoved from the bore of the nail afterthe latter has been'properlypositionedin the'fracturedneck of the femur. The

Smith-Peterson nail for an adult is about five incheslong and has adiameter of five-thirty-secends of an inch although it is flanged andgenerally triangular in cross section. It extends through a hole drilledin the hard outer portion cfthe'femu'r, thehole extending in line withthe center of theacetabulum at approximatelya 20 anterior angle.'-The=nails eX-tends'through the neck and preferablyinto thehea'd orball-like -portion of'the hip joint, ndits function is'of course tore-enforce the head on the neck of the femur. For the best results, thenail must be nearly in the direct weight-bearing-line of {the joint andso positioned that-it receives the support of the dense corticle'boneonboth sides of .the distal fragment. The insertion of both the guidepin-and the nail must be controlled at all A proposed apparatus foraccurately placing .the guide wire or pin, and'hence the nail, in

proper position in the fractured bone, compre- .EhGHdS .a supporting andguiding means for the :guide .pin or wire, 'whichmeans includes a postvertically and rotatably adjustable inabearing, and it'is the objectofthe present invention to provide a novel and advantageous means wherebyan approximateadjustment of said post may first be made, and later whensaid approximate a'djustment has been checked by radiography, to permitmaking a fine adjustment to accurately position the guide pin or wire.

In the accompanying :drawings; Fi ure Lis e side elevation.

(c1.:i.-24s;arc1

Figs. 2, '3-"4-sand 5 afte -detail horizontal sec- -.-tional mew on thecorrespondingly numbered dines of 'F-ig'. i.

eager cam 7 are detail-vertical sectional -v-iews 5 (a rlines- 6 6 andI-A-lwof "-Fig. 4.

:Fig. 8'is" a detaihrear elevation as indicated by line- 8 8 -of -Fig.1.

=F i-g. 9;is a *fragmentary vertical sectional view line 9-9 of Fig.-'8. "g.- 1 is a horizcntal sectional view on line 415-40 of "Fig. *1;

'Fi-g. 1 1 is an enlarged detail horizontal section en =line il l--'=l l.of =Fig. 12 1s a -fragmentary elevation of a por- 15 tion ofthe-sideopposite-that shown in Fig. 1.

Fig. I3 "is an enlargeddetail vertical section on r line l 3-'-=l 3 of"Fig; 4.

-1-4-is a fra gmentary enlarged view similar {to asportion of Fig.4,partly in section.

In -these figures in which'likereference charasters -=indicatecorresponding parts, =20 denotes -g enerally-anupright supportrisingfrom a-base'2l an'd carrying preferably at its top a transverselyextendin g'uiding-"or dir-ecting member "22 for thepingfistilfiro 7element whichis'tobe-sup- :pcftedandguided:initsiongitudmal;siidmgmovement toward a predetermined point. Thesupport 'iflincludes avertical pst 'ZS, the lower porition :of which acylindrical and mountedfor :slidable and i dtatable movements in an upright tiibulai guide orhearing fl whichhas its lower '2end fixdinsthe center of the basem. Thelatter preferably square as shownin l ig. 10 and adjacent its {fourcorners-are leveling feet 25 in the 3'5 term of screws threaded throughthe base or -throughnuts= mountedtherein. To assist in lev- -;e1ing thebase, spirit levels 25 inay'be set in the lcase-iiush-=with its uppersurface at points be- "tWen 'ltSuGOmM-sf and center. 7

'iTh base 2*l is'to be-securedlcysuitable clamps n-(notshown) on' thetop of an operating table or qthe alike after 'repe'r' "leveling andafter proper positioning- 6f the insti umerit with respect to theZpati'erit. iEhe body of-the patient is of course im- Lmobilize'd lby lthe usual means associated with yfractureand-operating tables. When thetable cor other-supportonwhichthe patient is held has not a suificienttp area to receive the 'base 2!, litymay beocnteq on any suitablesupport which "'50 .will ieperniit git to be 'p'iopeijly positioned both'ileng thwise andlaterall-y' with respect "to the patients eddy.

" JIhelowerend of post '23 is supported on a ifollo'wer platen whichis-vertically' adjustable in tl'ie' fixdd guidetube 2 4 and to centertlie pdst,

, tightening screw 39.

its lower extremity enters an upstanding annular flange 28 formed on thefollower and having an inwardly and downwardly beveled edge as shown inFig. 1.

While any suitable means may be provided for adjusting and securing thefollower in order to vertically adjust and secure the post, I preferablyform on the edge of the follower a laterally projecting arm 29 fromwhich rises a rack bar 30. These parts are in a laterally projecting andlongitudinally extending extension 3| formed on tube 24 as shown inFigs. 1 and, 2. Engageable with the rack through an opening in extension3! is a pinion 3| fixed to the inner end of a shaft 32, the outer end ofwhich has a hand-wheel 33. Shaft 32 is journaled in a bearing 34projecting from extension 3| as shown in Fig. 2..

The upper end of tubular guide 24 is formed with two spaced verticalslits 35 to provide a spring finger 36, the upper portion of which iswithin a collar 3'! surrounding the upper portion of the tube 24. Thecollar has an upper inturned flange 38 to rest on the upper end of tube24 and on its side is formed a lateral boss through which is threaded aclamping screw 39 adapted to enease the outer face of the spring finger36. Within the upper portion of tube 24 and between it and the post 23is a split bushing 40 substantially coextensive in length with thelength or height of the collar as shown in Fig. 13, the longitudinalsplit in the bushing being spaced 90 from the axis of screw 39 as shownin Fig. 3. The bushing and the collar are held in their proper positionsat the upper end of tube 24 by a bolt 4| which passes through thesethree parts. Bolt 4| has its head countersunk in the inner face of thebushing and a nut is threaded on its outer end. The bolt is locateddiametrically opposite screw 39 as shown in Fig. 3. It will be seen thaton tightening the screw 39, the tube 24 will be frictionally locked tothe bushing and the latter will be contracted around the post 23 so thatthe post will be clamped and secured against rotation in tube 24 andwill also be held against upward sliding movement. When clamp screw 39is loosened, post 23 may be rotated and it may be raised or lowered byturning hand-wheel 33.

By grasping and rotating post 23 an approximate adjustment of the pinguiding element 22 to an angular position in a horizontal direction maybe made and that position then secured by It is desirable, however, tohave a finer adjustment of element 22 in a horizontal direction, thatis, about the vertical axis of post 23. To permit that being done, thecylindrical portion of the post is formed with a .plurality of key-waysor grooves 42 which receive keys 43 formed in the bore of a collar 44surrounding post 23, the collar being thus slidably but nonrotatablymounted on the latter. Projecting radially from collar 44 is an arm 45,the upper edge of which curves downwardly and merges into a fiatsegmental plate 46 formed at the outer end of the arm and having on itsupper face a Vernier scale 41. The latter coacts with a scale 48 dividedinto 360 and arranged on the upper face of a track or ring 49. This ringis concentric with the axis of post 23 and is supported by three radialarms or spokes 59 whose inner ends are secured at to the top of collar31. Rotatably mounted on post 23 and positioned between the hub 44 ofthe Vernier arm and arms 5| supporting the graduated ring 49, is the hub52 of an adjusting and clamping arm 53. The latter is radially disposedas shown in Fig. 4 and its outer. end terminates .frictionally lock arm53 to ring 49.

close to the inner edge of ring 49. Carried by the outer end of arm 53is a vertically disposed clamping bolt 54, the fiat head 55 of which isslidably engaged with the lower side of an annular flange 59 formed onthe inner edge of ring 49. This bolt 54 passes freely through a clampingsleeve 51 and has a milled-edge nut 58 engaged with its threaded upperend, as shown in Fig. 6. Sleeve 57 has a transverse threaded opening toone side of its bore to receive a slow motion adjusting screw 59, oneend of which is secured by a ball and socket joint to one side face ofthe arm 45 as shown in Figs. 4 and 14. The lower end of sleeve 51frictionally engages the upper face of ring 49 and of arm 53 so thatwhen nut 58 is screwed down on bolt 54, said parts will be clampedbetween the head of the bolt and the sleeve to It will, therefore, beseen that when these parts are clamped together while screw 39 is loose,the rotation of slow motion screw 59 will cause arm 45 and hence post 23to turn with respect to ring 49 and the verm'er scale 41 will move withrespect to t e scale graduations 48, to thus obtain a fine angularadjustment of the pin guiding member 22 about the axis of post 23.

The angular adjustment in a vertical direction of the pin guiding memberor element 22 is preferably obtained by the structure mounted on theupper part of post 23 and shown more particularly in Figs. 1, 8, 9, l1and 12. The body portion of member 22 is preferably V-shaped in crosssection as seen in Fig. 8 so that it is channeled or troughshaped tosupport and guide the pin, the latter being indicated in dotted lines inFig. 8. About midway of the body portion of member 22 is an integraldepending shank'or stem 60 having a transverse width equal to the widthof the body and also having side faces which may be engaged by the armsof an inverted U-shaped spring clip 6!. The central or connectingportion of this clip extends across the groove or trough in the body ofmember 22 to hold or retain the pin therein, particularly when X-raypictures are being made. The clip is of course readily engageable withand disengageable from said guiding member. The lower end of shank 60 isreduced in thickness as shown at 62 and this reduced portion is formedwith a recess 63 shaped to fit a squared central portion of a shaft 64.A screw, pin or the like 65 fastens these .parts together.

Shaft 64 is mounted for oscillation at the top of post 23, the upperportion of which is square in cross section as seen in Fig. 5. The topof post 23 has a transverse recess'to receive the reduced lower end 62of the stem or shank, the recess forming spaced bearing ears 66. Thelatter have circular bearing openings to receive cylindrical portions6'! and 68 formed on shaft 64 beyond its squared central portion asshown in Fig. 11. At the outer side of the portion 61, the shaft isformed with another squared portion 69 which enters a square hole at theaxis of a protractor Hi. The graduations H on the latter coact with aVernier scale 12 arranged on a segmental plate 13 secured to a flat faceof the squared upper portion of post '23, as shown in Figs. 8 and 12.

Mounted 0n the cylindrical bearing portion 68 of shaft 64 is a rotatablyadjustable sleeve or hub 15 carrying a depending flat arm 16. A setscrew 11 in a threaded boss on hub 15 is adapted to engage the portion68 of shaft 64 to lock arm 16 for movement with the shaft. This clampingscrew 11 permits of an approximate vertical angular adjustment of thepin guiding member 22 assent when the-lowerend of arm '16 is elampedbetween "fastened at its center-in a recess in the flat face of post 23as. shown in Fig. 1. "When a finer adjustment of member 22 in a verticaldirection is desired, the slow motion screws 18 are adjusted to move thearm 16 and hence, shaft 64 and protector relative to post 23. In thisadjustment, the graduations TI on the protector are shifted relative tothe fixed Vernier scale 12. The extremities 'of shaft 64 maybe threadedto receivea iihreaded cap screwi a l -at one endiandaa nut at the otherend. to hold the parts-iassembled as shown in Fig, 11, i The cylindricalportion of post 23 isfprovi'd'ed with graduations .83 which-inlay beread in connection with the upper edge of hub or collar 44 so that thevertical adjustment of the pin guiding member 22 may be noted. Thecoacting scale graduations showing the horizontal and vertical angularadjustments of member 22 may also be noted so that such adjustments maybe returned to at another time if necessary or desirable. When clampscrew 39 is loosened, the post 23 and all parts which it supports, maybe removed from the. guide tube 24 to permit such parts to besterilized.

The use and advantages of the apparatus to correctly position the guidepin in a fracture of the neck of the femur will be readily understoodfrom the foregoing by a surgeon familiar with hipnailing and. theSmith-Peterson technique. Its use may, however, be briefly stated asfollows: After the patient is secured in the proper position on thetable, the instrument is leveled, properly positioned and then clampedto the table in the proper position relative to the fractured joint. Thepin is placed in the guiding member 22 and held in place by the clip.Member 22 is then adjusted vertically to the proper height by turn inghand-wheel 33. Approximate adjustments of member 22 as previouslydescribed, are then made to give the pin the proper angular dispositionboth horizontially and vertically. X-ray pictures in both vertical andhorizontal planes are made to check the position of the pin with respectto the fractured bone. The finer adjustments may then be made andfurther X-rays are-taken to see that the pin is directed properly withrespect to the fracture. made, the drill which cuts through the hardouter portion of the bonemay be guided by the member 22. The pin whilein member 22 is slid or pushed along its trough or channel and isgradually pushed through the soft inner portion of the bone, X-raypictures being taken from time to time to see that the pin is properlydirected. After the pin has been properly positioned, the hole is reamedto the proper size for the Smith- Peterson nail which telescopes thepin. The guiding member 22 maybe used in guiding the reamer and thenail. When the nail is properly positioned, the pin is removed and theincision is closed.

The use of the apparatus will greatly shorten the time necessary forperforming the operation and insure the accurate positioning of the pinand nail by a surgeon not particularly skilled in that class ofoperations. While the invention has been described as particularly Welladapted to the nailing of hip joints, it will be understood that it maybe put to other uses.

To those skilled in the art, changes in or modifi- After the incisionhas been cationid'iirthe above aestnbeaiembmiimeritsf my invention willbe suggested andmay be iiiad'e .-without departing from the inventiveconcept -thereoff. "Reference is, therefore-g to be had to the appendedicl'a'ims to determine the scope of the presentinvention. 1 l

- Whatyisc'lai'iried'is':

i ilm" an apparatus"oftne -cl'assdescribed, a post, a bearing retatabi-ymountin said post, a track concentric with saidbea-ring means fixed-1ysecuring said track to Said bearing, one radial arm connected-with saidpost forrotation with the latterysaid onearmfiextending to said track, asecond radial arm "circumferentially spaced from said one arm and havinga hubrotatably surrounding saiii pestgmeansccnnectingthe two aforespii'ei armswh vtiiiie saicrpastis-b eiiigturned in saia beanng toan approximate desired position, and means for securing said second armto said track after said post has been turned to said approximateposition, said arm-connecting means including manually operableadjusting means for moving said one arm toward or from said secondarmafter the latter has been secured to said track, to obtain a fineangular-adjustment of said post.

2. In an apparatus of the class described, a post, a bearing mountingsaid post for rotative and endwise adjustment, a track concentric withsaid bearing means fixedly securing said track to said bearing, oneradial arm over said bearing and extending to said track, said one armhaving a hub through which said post extends, said hub I being slidablyconnected with said post to rotate with the same and to permit endwiseadjustment of said post in said hub, a second arm circumferentialyspaced from said one arm and having a hub through which said postextends slidably and rotatably, means connecting the two aforesaid armswith each other and effective to cause said second arm to move with saidone arm while said post is being turned in said bearing to anapproximate desired position, and means for securing said second arm tosaid track after said post has been turned to said approximate position,

said arm-connecting means including manually operable adjusting meansfor movin said one arm toward or from said second arm after the latterhas been secured to said track, to obtain a fine angular adjustment ofsaid post.

3. In an apparatus ofthe class described, a post, a bearing rotatablymounting said post, a track concentric with said bearing means fixedlysecuring said track to said bearing, one radial arm connected with saidpost for rotation with the latter, said one arm extending to said track,a second radial arm circumferentially spaced from said one arm andhaving a hub rotatably surrounding said post, a manually operable clampcarried by said second arm and engageable with said track to secure saidsecond arm to said track when desired, said clamp inc uding a clampmember mounted on said second arm and turnable about an axis parallelwith said post, an adjusting screw threaded through said clamp member atright angles to said axis, and means connecting said adjusting screwwith said one arm, whereby prior to tightening said clamp, both of saidarms may turn with said post when turning the latter in said bearing toan approximate desired position, and after tightening said clamp turningsaid adjusting screw will move said one arm with respect to said secondarm, thereby turning said-t post. to obtain a-fine angular ad-.-justment of the latter.

4. In an apparatus of the class described, a post, a bearing rotatablymounting said post, a

track concentric with said bearing means fixedly having a headunderlying said track, a sleeve upon said bolt and resting on the uppersideof said track, a nut on said bolt for moving said head and sleeveinto clamping engagement with said track to lock said second arm to said.bearing after said post has been turned to a desired approximateadjustment, an adjusting screw threaded transversely through said sleeveat one side of said bolt, and means connecting said screw with said onearm, whereby said screw may be operated to move said one arm and obtaina fine adjustment of said Dost.

MARION F. STEPHENS.

REFERENCES CITED The following references are of record in the file ofthis patent:

V UNITED STATES PATENTS Number Name Date 2,148,692 Guinn Feb. 28, 19392,204,809 Miller et a1 June 18, 1940 2,226,708 Cleary Dec. 31, 1940Lippincott Dec. 23, 1941

